Specialities for higher trainees

Working in child and adolescent mental health services (CAMHS)

Working as a child and adolescent psychiatrist is a fantastic opportunity to make a difference to the lives of young people.

It’s a challenging specialty which has seen tremendous developments over the last two decades and is continuing to make great strides forward. It combines the rigours and science of medicine with the art and creativity of therapy.

There are many approaches to treatment including cognitive behavioural therapy and family therapy. Medication and admission to an inpatient unit may occasionally be used, but this is less frequent than for adult mental health services.

Child and adolescent psychiatrists believe in the importance of family and community and this is reflected in the services we provide at Sussex Partnership.

We work with colleagues who hold skills in different areas and partners from other organisations such as schools, social services, hospitals and the police.

Our trainees are given opportunities to be involved in different forms of therapy, such as group work with children and with adolescents, Cognitive Behavioural Therapy and family therapy with support and guidance from specialists. There are often opportunities to see young people at school and at home.

The service is also in the process of exploring a youth model for 14 – 25 year-olds and also works closely with colleagues in Early Intervention in Psychosis as well as the young peoples’ Substance Misuse team.

People with learning disabilities have significantly higher rates of mental health problems than the general population, not least because they experience more biological and psychosocial risk factors.

Specialist psychiatrists not only offer treatment for severe mental illness, but also for a wide range of other mental, physical health and behavioural problems.

Neurobehavioural conditions such as autistic spectrum disorder, ADHD and Tourette’s syndrome are seen quite commonly and epilepsy is much more prevalent.

Psychiatrists working with people who have a learning disability need to have a wide range of clinical skills. The clinical work is often made more complex because people with learning disabilities often also have other physical problems such as epilepsy and cerebral palsy as well as other conditions with can present diagnostic challenges.

Working with other health disciplines such as occupational therapy, speech and language therapy positive behavioural specialists, physiotherapists, psychologists and neurologists is crucial to the role of psychiatrists working in this speciality and means the culture is always one of learning.

Currently no posts in this subspecialty.

Working in liaison psychiatry

Liaison psychiatry is a young and developing specialty.

Liaison psychiatry teams provide the psychiatric service for general or acute hospitals (and occasionally other types of hospital as well). They often treat people who are severely unwell, and have to balance people’s need for psychiatric treatment against their need for physical treatment.

Most liaison psychiatrists treat working age adults (18 - 65yrs) and many also see and treat older adults.

Liaison psychiatry is sometimes known as psychological medicine or consultation-liaison psychiatry.

If you specialise in liaison psychiatry, you are likely to be based in a general or acute hospital, rather than in a psychiatric hospital.

If you like a diagnostic challenge, you like working in a hospital, and you enjoy the more acute aspects of psychiatric practice, then liaison psychiatry may be a career for you.

Compared to other branches of psychiatry, liaison psychiatrists usually have considerable contact and interaction with hospital doctors (e.g. emergency physicians, neurologists and surgeons).

The age demographic across the area Sussex Partnership covers is one that’s getting older so more patients than ever now require the attention of old age psychiatry.

There has also been an expanding demand for early memory assessment and anti-dementia drug treatment which is now an important part of the work of old age psychiatrists as well.

Old age psychiatrists work closely with primary care and other agencies such as social services. Specialty training in old age psychiatry recognises the need to have a good understanding of the effect of physical health problems on patients’ mental health.

Specialists work closely with patients’ families who often have an informal role in patient care which is an important aspect of the consultant role.

Forensic psychiatry is a unique field of psychiatry which deals with the assessment and treatment of mentally ill offenders.

It requires sophisticated understanding of the criminal justice system and offending behaviour.

Forensic psychiatrists have to balance the needs of the individual and the risk to society. They provide medical treatment and rehabilitation as part of a multi-disciplinary team in a secure environment, where patients are subject to legal restrictions.

Assessment and treatment settings vary, from high security hospitals through to medium secure units, low secure units, prison settings and community based services.

Knowledge of mental health law is central to the work of a forensic psychiatrist and there is also regular involvement with criminal justice agencies and the courts.

The majority of patients have had contact with the criminal justice system, although a minority are referred from NHS facilities (if their behaviour is challenging and they pose a risk which cannot be safely managed in less restrictive environments).

Forensic psychiatrists also provide specialist advice to the courts, the probation service, the prison service and psychiatric colleagues.

Most people addicted to substances are actually using the alcohol or drugs to overcome underlying problems or difficulties.

Prevalence of Dual Diagnosis (mental health problems in addition to the substance misuse problem) can be as high as 40%.

Physical problems attached to addictions are also common, and they can be as a consequence of the physical harm that the substance is causing to the body (like liver cirrhosis), the method chosen to use the substance (Hep C through sharing injecting equipment) or a primary problem which has led to the use of the substance (chronic pain which gets ameliorated with the use of alcohol or opiates).

Substance misuse psychiatry is about far more than prescribing a detox regime. Excellent diagnostic skills are needed to get to the bottom of the problems which lie beneath the addiction.

Team working is essential and this field brings an exciting opportunity to work with different colleagues from many backgrounds.

Substance Misuse is an essential part of the training for all psychiatrists and general practitioners who will encounter substance misuse problems. Early detection and appropriate care can change someone’s life.

Many trainees specialise in this field because they like the balance of art and science. Clinicians have to be able to engage with people in meaningful ways at times when they are often in states of turmoil and distress whilst being supported by knowledge of anatomy, physiology, psychology and pharmacology.

The work encompasses the care of people in hospital and community settings and psychiatrists are supported by multi-disciplinary teams. They may have a broader role working in an outpatient setting or an inpatient unit or sometimes a mixture of the two. They will also work within newer services, such as:

Medical Psychotherapy is a specialty within psychiatry and there are currently two consultant psychiatrists in psychotherapy at Sussex Partnership, one of whom is the Psychotherapy Tutor.

There are two main classes of treatment in psychiatry, physical treatments and psychological treatments. It is therefore essential for every psychiatrist to understand the principles behind psychotherapies in general, and something about each of the main types of psychotherapy.

The training programme in psychiatry includes mandatory teaching and experience in psychotherapy as part of both the core and higher training experience.

A core psychiatry trainee in Sussex will have opportunities to take at least two psychotherapy cases under expert supervision, and to have a variety of different types of therapy potentially open to them – typically Cognitive Analytic Therapy, Cognitive Behavioural Therapy, Psychodynamic Therapy, or Systemic Family Therapy.

Many trainees find that their psychotherapy experience is one of the most interesting, different, and challenging aspects of their training.